Diegel Chiropractic Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- Download the necessary form(s), print and fill in the required information.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
New Patient Forms - Required
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Please download and print the following forms. Complete the forms and bring the completed forms with you to your appointment.
Good Faith Estimate & Disclosure Form
Please fill out this form to bring to your first appointment.
The attached document will go over possible fees you may experience at our office. Just because a fee is listed does not always mean you will get charged for that service.
The below form is strictly to provide an estimate of fees for services provided. If you have any questions about the fees or your insurance coverage or lack thereof please call our office at 586-254-2060 and we will be happy to assist you.